Carroll area's legislators split on Medicaid expansion

The Carroll area's two representatives in the Statehouse disagree on a crucial issue before Iowa's political leaders: whether to take federal money and expand Medicaid in Iowa to cover more uninsured people or go it alone with IowaCare, a state-based system that provides care to the needy, but only in Iowa City and Des Moines.

Gov. Terry Branstad has signaled his support of IowaCare, stressing concerns about being tied to the federal government. An Iowa Senate subcommittee already has passed a measure to expand Medicaid, which The Quad-City Times and State Sen. Mark Segebart, R-Vail, report could add another 150,000 to Medicaid, which now serves 400,000 people. State officials have said the expansion could add 110,000 to 180,000 people.

"I think right now Medicaid expansion is probably the best game we have going," said State Rep. Dan Muhlbauer, D-Manilla.

He said Medicaid expansion will help maintain property-tax levels as many hospitals in Iowa are county-run. What's more, all hospitals absorb charity costs when the uninsured show up in emergency rooms, Muhlbauer said.

"What do we do?" he said of how the state handles thousands of uninsured. "We go to the into the emergency room, and the emergency room is the most expensive plan."

Under the Affordable Care Act, federal health reform widely known as Obamacare, states can opt into Medicaid expansion with 100 percent of the costs covered by the federal government for three years, with a 90 percent federal and 10 percent state split in ensuing years.

Segebart said he wants to protect the current state system as it has more qualifications, making it less likely recipients are taking the government for a ride.

"I'm promoting the IowaCare system, the system that we're in," Segebart said. He wants to see IowaCare improved.

That said, Segebart noted that even Republican governors differ on this issue. For example, Florida is opting into Medicaid expansion, while Wisconsin isn't.

According to the Miami Herald, Florida Gov. Rick Scott said he supports expanding Medicaid and funneling billions of federal dollars to Florida, "a significant policy reversal that could bring health-care coverage to 1 million additional Floridians."

"While the federal government is committed to pay 100 percent of the cost, I cannot, in good conscience, deny Floridians the needed access to health care," Scott, a former hospital executive, said.

Meanwhile, Wisconsin Gov. Scott Walker has signaled plans to improve on the state program, BadgerCare.

"We need to break cycles of generational dependence on the government," Walker said in a statement, according to Forbes magazine. "Reforming entitlements, like Medicaid and unemployment insurance, puts an emphasis on independence and the dignity that comes with working hard to build a prosperous future of your own choosing."

The debate between Muhlbauer and Segebart on Medicaid expansion came Saturday morning during a Carroll Chamber of Commerce legislative forum at St. Anthony Regional Hospital. About 60 people attended the hour-long session.

On the education front, Muhlbauer stressed that the state needs to deal with overall education funding before diving into reform on teacher pay, evaluation and other school issues.

"We need to set allowable growth," Muhlbauer said, adding that the governor is holding legislators "hostage" by demanding a massive reform package by the House be considered in the Senate along with allowable growth - a formula that determines how much state money flows to local school districts based on enrollment. The Republican-controlled House passed an amendment to the reform bill setting it at 2 percent. The Democratic-led Senate set the rate at 4 percent.

Segebart said allowable growth is supposed to be considered as a stand-alone bill - a view in opposition to the governor's approach.

Both Muhlbauer and Segebart were open to legislation that would end straight-party ticket voting in Iowa.

Segebart said there is no cost associated with the measure - and that it might actually end up saving some dollars with less use of ink on ballots. The plan also would make it more likely Iowans would go through the full list of candidates and cast votes down-ballot for judges and other local positions.

"I don't think there's any controversy with this," Segebart said.

Iowa is just one of 15 states that continues to allow straight-ticket voting.

Segebart suggested making Election Day a national holiday to promote more voting - perhaps with a major football game held in the evening to cap the celebratory aspect of the day of democracy.

Muhlbauer said he had no opposition to killing straight-ticket voting, but did not view it as a pressing issue.

"The biggest thing we want is to get people out there to vote," Muhlbauer said.

But on the elimination of straight-party voting, he added, "Is it going to be that important of a thing? I really don't think so."

When pressed on voting issues, Segebart said he didn't believe voter fraud is a "major concern" in Iowa.

Carroll resident Nick Topf urged the legislators to support a measure that would rein in payday-loan operations by limiting the number of loans they can make to individuals during a given period of time. Both legislators said there are hundreds of bills floating around in various forms and they weren't dialed on that plan.

"Typically, there's so much going on that you have to read it in the paper," Segebart said.

Asked about potential legislation dealing with firearms, Segebart said a variety of bills are before the Legislature.

"For me, this a mental-health issue more than it is a gun-control issue," Segebart said.

Muhlbauer said the debate on guns is not front-and-center in terms of immediate legislative business.

"There's very little talk in Des Moines about it at all," Muhlbauer said.

Muhlbauer, a cattleman, said he is promoting legislation that would provide tax-credit incentive for beginning farmers.